W3 - LRTI in Adults (Incomplete objectives)

Question 1

4 symptoms of acute bronchitis and 2 additional reasons to visit GP

Answer 1

3+ week cough
3+ day fever
Sputum (haemoptysis)
Breathlessness

Should see GP if heart/lung condition or repeated episodes

Question 2

Is bronchitis viral or bacterial?

Answer 2

Usually viral

Question 3

How do you treat bronchitis

Answer 3

Supportive management, e.g. fluids, paracetamol

Question 4

Give 5 symptoms of COPD exacerbation

Answer 4

Change in colour of sputum
Fever
Increased breathlessness
Wheeze
Cough

Question 5

What 3 viruses can cause a COPD exacerbation?

Answer 5

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

Question 6

What 3 things can you do to treat a COPD exacerbation

Answer 6

Steroids
Antibiotics (amoxicillin, doxycycline, co-trimoxazole, clarithromycin)
+/- Nebulisers

Question 7

What 8 viruses can commonly lead to LRTI?

Answer 7

Streptococcus pneumoniae
Haemophilus influenzae
Legionella
Staph aureus
Moraxella catarrhalis
Mycoplasma pneumoniae
Clamydophyla psittaci
Coxiella burnetii

Question 8

If a patient has influenza, what secondary infection might they acquire?

Answer 8

Staph aureus

Question 9

Aspiration pneumonia can occur in what 5 conditions?

Answer 9

Stroke
MS
Myasthenia
Sedation
Oesophageal disease

Question 10

Aspiration pneumonia is usually caused by what category of bacteria? What 2 antibiotics can treat it?

Answer 10

Anaerobes

Amoxicillin + metroiclazole

Question 11

Give 3 examples of immunocompromised patients. Name 2 funguses and 3 viruses they are prone to

Answer 11

Haemotological malignancy
Neutropenia
HIV

Fungus - aspergillus fumigatus, candida

Viruses - CMV, HSV, VZV

Question 12

What type of bacteria is likely in HIV+ patients? How can we investigate? What antibiotic can we give?

Answer 12

Pneumocytosis jiroveci pneumoniae

Broncoscopy is useful

Treat with co-trimoxazole

Question 13

What antibiotic can we use in MRSA?

Answer 13

Vancomycin

Question 14

In what 2 ways can we diagnose empyema?

Answer 14

Thoracic ultrasound +/- aspirate

Question 15

What are the fluid parameters for simple, complicated and empyema?

Answer 15

Simple: pH > 7.2
Complictaed: pH <7.2
Empyema: pus/Culture +ve

Question 16

In what 4 ways can we treat empyema?

Answer 16

Drain
Prolonged antibiotics
Surgery
Intrapleural tPA + DNAse

Question 17

What is intrapleural tPA + DNAse

Answer 17

This is a procedure which involves putting 2 drugs into your pleural space via your existing chest drain
.
tPA (alteplase) is a ‘clot busting’ drug which breaks down the protein component in the pleural fluid to aid its drainage.

DNase (dornase alpha) is a drug which makes the fluid less sticky/viscous to aid its
drainage.

Question 18

What category of bacteria is likely to cause a lung abscess? Give 2 types

Answer 18

Anaerobes
Staph aureus
Pseudomonas

Question 19

2 symptoms of lung abcess

Answer 19

Purulent sputum
Haemoptysis

Question 20

3 ways we can diagnose lung abscess and 1 treatment

Answer 20

Screen for TB
CT Scan
+/- Bronchoscopy

Prolonged Abx